There’s a saying in my line of work — “you change what you measure.” This is as true as most sayings, that is, it’s sometimes true, and there’s an element of “be careful what you wish for/measure” in there, too.

Yesterday, I was at my doctor’s office and saw a publication I hadn’t seen before, Scholastic Parent and Child magazine. Like other glossy parenting monthlies, it’s meant to sell stuff to parents — both products and larger concepts, and to capitalize on guilt, shame, worry and fear. Parenting, I’ve found, especially the somewhat isolated version of it that I practice, is filled with worry and guilt, some fear and the least shame I can manage.*

The cover of the magazine had a lovely photo of the First Family, and I couldn’t stop myself from reading cover article, “Mom on the Move“. Which you can read yourself. There are things that made me cringe throughout the article, but what jumped out at me first was this:

The first lady is the first to admit that turning the ship around won’t be easy. In the past 30 years, childhood obesity rates have tripled. Today, nearly one in three children in the United States is overweight or obese. But as staggering as those numbers are, “they don’t tell the full story,” Mrs. Obama said at the Let’s Move launch at the White House in February. “This isn’t just about inches and pounds and how our kids look. It’s about how our kids feel and how they feel about themselves. It’s about the impact we’re seeing on every aspect of their lives.”

As part of Let’s Move, the American Academy of Pediatrics is proposing that all pediatricians do what the Obamas’ doctor did: Calculate BMI for every child at every well visit. Parents will also leave the pediatrician’s office with ideas for increasing healthy eating and active play. “A prescription for better foods and more exercise is just as important as a medicine prescription,” Secretary of Health and Human Services Kathleen Sebelius told P&C.

Some of us have been through this already — the dreaded weight check, the growth chart with our own weight plotted on it, being told we were above the 90th or 95th percentile, as if we didn’t feel awkward and different and ill-fitting-in-our-own-skin to begin with — “hey, your weight is freakishly high for your height and age, kid!”

But what about kids who have BMIs in the more-or-less okay (or even underweight) range? We care about them, right? That’s 2/3 of the population of kids, no? So, if their BMI is in the okay range, they don’t get scrutinized about their eating habits and exercise habits. There are many associations between sedentary behavior and poor health, and certain dietary patterns and poor health — both of these, for example, have implications for bone health that is essential for the ability to be regularly physically active throughout the lifespan — regardless of BMI status.

Here’s how it went down** at the well-child visit for Sasha and Malia:

The pediatrician pulled Mrs. Obama aside to tell her that something had changed. He had noticed a slight up tick in her daughters’ Body Mass Index (BMI) — a measure of body fat based on height and weight. He urged her to take a look at what her kids were eating. “I was shocked at first,” Mrs. Obama recounted to CNN’s Larry King. “I thought I was doing what I was supposed to do, and I hadn’t noticed any changes in my kids.”

Had there not been “a slight up tick in her daughters’ BMI,” presumably, the doctor wouldn’t have said anything. Here are two health-conscious, highly educated parents, whose daughters diet has room for improvement — more fruits and vegetables, less processed foods — and it’s BMI that drives the change. Not worry about processed foods, or the labor conditions of the fast food workers, or the food safety issues, or the impact of not eating family meals, or a myriad of other things that can have a lasting impact on children’s lives. No matter the BMI of a child, there are patterns of eating, the where, when, how, how it feels while you are eating, that make surprisingly big differences in children’s health on a wide range of issue. For more about this, I highly recommend the blog Family Feeding Dynamics. I can’t expect, as a parent, to “outsource” the aspect of my child’s growth and development related to eating and then be surprised that the outcome isn’t what I hoped for in terms of health, growth and development. I do not care about BMI, or weight per se, I care that children have what they need in order to grow and develop. All children.

My daughter has her dad’s genes when it comes to body shape — she’s quite lean and muscular, that’s how she will likely continue to be. She won’t inherit my big breasts or tummy, that’s just how it goes. If I switched from her usual diet to one that had more fast foods/processed foods, I honestly don’t think her BMI would be different. But her health would most certainly be impacted. So if the doctor’s time is taken up punching BMI into the calculator and checking that little box in the electronic health record, and then the job is done since no nutrition or physical activity assessment is needed — it’s all neatly summed up by measuring BMI — then my daughter gets short-changed. Along with the other 70% or so of kids whose BMIs are not in the “overweight/obese” category.

In addition to causing permanent damage to the children whose BMIs are “high” — what is the cost to those whose BMIs aren’t high. Or are “low?” When we shift our focus to measuring BMI, we are shifting our focus away from something else. We aren’t adding 5 minutes to every doctor’s visit from now on, so what will that something else be?

It takes longer, and it’s harder to do, but I would rather, as a parent, answer some questions about our family’s eating habits, how much activity we get on a regular basis, how often we eat out, how often our kiddo is involved in preparing the meal. There are certainly instruments that could measure the “Ellyn Satter” factors in family eating and movement patterns. This would benefit children much more than a focus on BMI.

I don’t mean to stand on the sidelines and take potshots. I mean to have an impact on how “Let’s Move” is rolled out. There will be recommendations, trainings, and “pediatric obesity programs” and all sorts of other stuff that could be done in ways that could perpetrate harm or be beneficial, depending on how it all goes down.

I am very much in favor of the changes recommended overall, aside from the BMI measuring and the whole lack-of-evidence-based-ways-of-making-children-lose-weight-long-term-without-causing-greater-harm thing. These are things I care about. Including banning advertising to children (of food and other stuff, too).

Michelle, give me a ring. You and Sasha and Malia are welcome to come over for some dal, brown rice, homemade chapatis, and when they’re ripe, cherries and Persian Mulberries from our tree, more awesome fruits & vegetables from the Olympia Farmer’s Market, a walk in our neighborhood or a hike in the nearby park. I’ll share my ideas with you while the girls play with Bo.

* It’s also, for me, very joyful at the moment, even when I’m woken up every night from a deep sleep by my daughter for one reason or another, that’s normal now, so I’m usually not grumpy.

** Or the “spun” version of it, anyhow. It gets refined a bit with each article in a parenting or women’s mag.

8 responses to “This Just In – Is “Let’s Move” bad for 2/3 or more of kids?”

I hate, hate, hate, hate, that an educated woman like Michelle Obama is so easily manipulated by the OMG Obesity Epidemic people and doesn’t talk to people like Ellyn Satter about how to feed our children better without that food being about their weight. My entire childhood was a engulfed in dieting and exercise, very little of it sensible, and very little of it productive, and for our First Lady to sentence any child to that just makes me sick. My biggest hope is that someone can get through to Mrs. Obama and she can rethink her plan, but given how unlikely that is, I hope the kids survive better than I did.

You make an amazing number of good points here. The version I’ve heard is “what gets measured gets done,” and it’s very true.

If BMI is your goal, then it’s easy to ignore how healthy or unhealthy the behaviors to get there are. A thin person who eats like crap can be told “You must be doing something right” because they happen to have a fast metabolism, and a heavy kid might be encouraged to starve or over-exercise.

I used to teach writing to pre-teens, and I remember being very careful to leave page/paragraph count open-ended. If what I “measured” was the number of paragraphs or sentences, then I could rest assured that at least some kids would make their writing worse (for example, needless repetition or breaking complex sentences into choppy ones) to hit that goal. Kids will give you what you ask for, so you need to make real sure to ask for what you actually want.

Just like, as a teacher, I’d rather see three clear, interesting paragraphs than five repetitive ones, I’d rather see a chubby kid enjoying good food and running around than that same kid skipping meals to get their BMI to a goal. And the stakes are way higher when we’re talking about kids’ health.

You know what? If Michelle Obama offers to come over and babysit every late afternoon and get my children exercising while I go to the store and buy vegetables to wash, chop, cook, make appealing, and force down the childrens’ throats, that would be a reasonably positive suggestion. I’d still turn her down, because get out of my life, you busybody. But it’s not nearly as obnoxious as “Get your children exercising and go to the store and buy vegetables etc. and we have nothing to offer to make this any easier but massively increased doses of SHAME!!!”

Nutritional problems have essentially been solved in the developed world. People aren’t dying of poor nutrition. This initiative is aimed at possibly reducing the problem of increased chance of developing conditions that create an increased chance of dying at a slightly younger old age.

The real problems now are the lack of jobs and security and money and time, and the overdoses of stress and fear. Those of us trying to get by in the real world out here really don’t need Michelle Obama’s kind of “help”.

I think it’s cool that you’re into healthy eating. That’s great for you and your kids. But are you really saying that the flaw in “Let’s Move” is that the use of BMI means your kids won’t get the benefit of the kind of grief fat kids will get? Be thrilled, honey.

Your critical review is right on — I definitely come from a more or less healthy eating (or at least when eating with people who prefer healthy eating to eating primarily for fun or convenience) perspective.
No one deserves grief.
If it were just as easy, tasty and cheap to eat foods with less sodium, saturated fat and added sugars some of the time, and having the delicious fat, salt and sugar, too, when that’s what you want — would that be your approach? If I didn’t have a husband struggling with severe mental illness that made it impossible for him to work, I would be eating and feeding my child much less healthy stuff. He’s a great cook and prefers to cook to eating out or prepared foods, it’s actually some paranoia on his part at play. I have to remind him that vegetables are something I like on the table.
I don’t assume anyone else SHOULD eat like I do, or like my husband cooks, but if they want to, I want to make that possible. I don’t want to ban any foods. But instead of spending money advertising foods to kids that don’t contribute to good health, I would rather have food companies figure out ways to make tasty foods that are better for everyone.
This isn’t anything new — that relatively wealthier people can afford more nutritious foods and people with less money are stuck with whatever they can afford to buy or have time to grow.
As a kid who was bugged about weight throughout childhood to very poor results, I would rather have my pediatrician look at my daughter as a whole child, not just her BMI — and if that includes calling me on the stuff I’m doing or not doing, well, that’s part of what I pay him for.

Calculating BMI at every healthy visit and then haranguing the parents every time there’s a small uptick is beyond ridiculous. After all, among the myriad things a slightly higher BMI could indicate is (GASP!) the fact that the child could be gearing up for a growth spurt. Or, you know, putting on more muscle, which weighs more than fat.

I’m absolutely with you. Conversations about how a child eats and how (s)he moves are pertinent to overall health. Pointing to one seriously flawed measure and basing all health advice on it is a recipe for disaster.

Yep, my youngest has inheirited my husband’s build, literally huge bones. When hubby went for physical therapy for a shoulder injury, the very good therapist told him that his shoulder joints were as big as most people’s hip joints. While hubby has lots of fat, when his body composition was measured and they calculated what he’d weigh at the “ideal body fat of ten percent”, it was two hundred seventy pounds. Given that the BMI says he should weigh about 180, he’d have to lose a hundred pounds of bone and muscle to get to a “normal” BMI. Youngest DS is going to be the same, and I anticipate he’ll get whomped by the BMI users at various times in his life. I plan much preventative information for him as he gets older, he’s nearly six so I haven’t done much yet.

So how old were Sasha and Malia at the time she got the big BMI lecture? They’re going on 12 and 9 now, so if this happened before B. Obama was sworn in, they probably weren’t double-digit ages yet. Sasha was what, maybe 6? How many pounds does it take at that age to be “out of balance on BMI”? One? Two? Not even that much? And with two thin parents — one of them very thin — whose body types they have obviously inherited, how fat could they possibly get, even if they tried? This is a serious case of “born on third base, think you hit a triple,” I’m afraid.

Does M. Obama not know that millions — yes, MILLIONS — of fat kids have their diets restricted already, have their “screen time limited” already, are forced to exercise more (where they can be pointed and laughed at by other kids!) already, and are still fat, fat, fat? I mean, gods, when are people going to frigging discover genetics and immigration already? I often hear the argument that “our gene pool hasn’t changed that much” to account for the increase in fat-fatty-fatties. Uh, yes it has…if our gene pool consists of every person on U.S. soil of reproductive age, regardless of citizenship status, you bet your tuckus that the “gene pool” is a lot less white than it was 30 years ago — and not only that, the white people are proportionally less WASP and more “ethnic,” too, which means a smaller percentage of the population with the genes to replicate “ideal” weight under anything approaching real-life circumstances.

Some day they’ll listen to you, and Ellyn Satter, and Linda Bacon, and maybe even me, because we’re frigging RIGHT. I just have to wonder: What happens five years down the road, when the proportion of fat kids in the population hasn’t changed at all? Or, worse, what if they engineer a minuscule drop in “obesity” rates and cause a whole hornet’s nest of other problems, like increased smoking rates, increased eating disorders, increased depression, etc.? Then we’ll see if this really IS about “looks” after all, won’t we?

Man, I hate this “focusing on appearance for your health” crap. It took me YEARS to get over hating exercise because I was always forced to do it. As soon as I wasn’t forced to do sports twice a week, I ended up doing two extra curricular sports, as well as going to the gym every day or every second day. I ate better as well. Once I was allowed to focus on my HEALTH which I could change, rather than my LOOKS, which I couldn’t, I was so much happier.

And BMI for small children is such complete and utter crap. They’re KIDS. The BMI is already total bullhonkey, and then they’re using it on people who’s bodies still haven’t figured out what they’re up to yet.